Cicin Irfan, Eralp Yesim, Saip Pinar, Ayan Inci, Kebudi Rejin, Iyibozkurt Cem, Tuzlali Sitki, Gorgun Omer, Topuz Erkan
Department of Medical Oncology, Faculty of Medicine, Trakya University, Edirne; Turkey.
Am J Clin Oncol. 2009 Apr;32(2):191-6. doi: 10.1097/COC.0b013e3181841f2e.
To evaluate the clinicopathologic prognostic factors in malignant ovarian germ cell tumors.
We reviewed the medical records of 70 patients treated from 1990 to 2006 at our center. Clinical data including demographics, stage, surgery, chemotherapy, survival, menses status, and fertility were collected from patients' charts.
Median age was 22 years (range, 9-68). The histologic subtypes included 36 dysgerminomas, 11 yolk sac tumors, 3 immature teratomas, 1 embryonal carcinomas, and 19 mixed types. The most striking clinicopathologic finding was a history of concomitant immunosuppressant therapy, which was observed in 2 patients. Two patients had contralateral sex-cord tumors at presentation and follow-up. During a median follow-up period of 4.6 years, 11 patients had recurrence. The median time to recurrence was 8 months (6-28 months). Recurrences appeared in the abdominopelvic cavity in 9 out of 11 patients. Only one could be salvaged with second-line chemotherapy. Cumulative survival rate was 97% and 60% in patients with dysgerminoma and nondysgerminoma, respectively. Nondysgerminoma histology and residual tumor after surgery were unfavorable prognostic factors (P < 0.001 and P = 0.015). Fertility-sparing surgery was as effective as radical surgery among all eligible patients. Of patients with known menstrual status, 96% had regular menses. Of the 8 patients who opted for conception among these patients, 7 delivered healthy infants.
Nondysgerminomas have an aggressive clinical course. New treatment strategies are needed for eradication of abdominopelvic disease at initial diagnosis and recurrent setting. Occurrence of malignant ovarian germ cell tumors may be associated with immunosuppression in some patients. Sex-cord stromal tumors may present with bilateral involvement. It is possible to maintain fertility after fertility-sparing surgery followed by chemotherapy.
评估恶性卵巢生殖细胞肿瘤的临床病理预后因素。
我们回顾了1990年至2006年在本中心接受治疗的70例患者的病历。从患者病历中收集临床数据，包括人口统计学资料、分期、手术、化疗、生存情况、月经状态和生育情况。
中位年龄为22岁（范围9 - 68岁）。组织学亚型包括36例无性细胞瘤、11例卵黄囊瘤、3例未成熟畸胎瘤、1例胚胎癌和19例混合型。最显著的临床病理发现是2例患者有同时接受免疫抑制治疗的病史。2例患者在初诊和随访时对侧有性索肿瘤。中位随访期为4.6年，11例患者复发。复发的中位时间为8个月（6 - 28个月）。11例患者中有9例在腹腔盆腔复发。只有1例患者通过二线化疗得以挽救。无性细胞瘤患者和非无性细胞瘤患者的累积生存率分别为97%和60%。非无性细胞瘤组织学类型和术后残留肿瘤是不良预后因素（P < 0.001和P = 0.015）。在所有符合条件的患者中，保留生育功能手术与根治性手术效果相同。在已知月经状态的患者中，96%月经规律。在这些患者中选择受孕的8例患者中，7例分娩了健康婴儿。
非无性细胞瘤具有侵袭性临床病程。需要新的治疗策略来在初始诊断和复发时根除腹腔盆腔疾病。部分患者恶性卵巢生殖细胞肿瘤的发生可能与免疫抑制有关。性索间质肿瘤可能表现为双侧受累。保留生育功能手术加化疗后维持生育功能是可能的。
